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Recently, the Journal of Clinical Oncology (JCO), the official journal of the American Society of Clinical Oncology (ASCO), published online the 50 most cited articles published in the journal during 20181.
Among them, a total of 3 Chinese scholars were selected as the first or corresponding authors of the research results, and there is only one study that is completely aimed at the Chinese population, which is a phase III clinical study 2 on neoadjuvant treatment of locally advanced esophageal squamous cell carcinoma.
The only clinical study on the treatment of hepatocellular carcinoma (HCC) was selected from a phase III clinical study led by a Singaporean scholar.
Both esophageal cancer and liver cancer are tumors with Chinese characteristics, and both have the highest morbidity and mortality rates in China.
Chinese scholars in the field of esophageal cancer treatment have obtained high-level evidence-based medical evidence recognized by the world.
It is gratifying and gratifying, but at the same time, it can not help but hope that Chinese scholars will make new breakthroughs in the field of liver cancer treatment research as soon as possible.
China is the country with the largest number of liver cancer cases in the world.
According to the latest global cancer burden data report for 2020 released by the International Agency for Research on Cancer (IARC) under the World Health Organization in February this year, there will be 410,038 new cases of liver cancer in my country in 2020, accounting for 45.
3% of the total global cases (905,677)4 .
About 80% of liver cancers in China originate from hepatitis B virus (HBV) infection.
At the time of initial diagnosis, nearly 80% have developed into intermediate and advanced stages.
The treatment is difficult and the prognosis is poor.
It is significantly different from HCC in Europe, the United States and even Japan.
Therefore, my country’s HCC diagnosis and treatment cannot be based on the experience of Europe, America and Japan.
It must be based on the Chinese population to obtain high-level evidence-based medical evidence, so as to formulate perfect HCC diagnosis and treatment specifications and guide clinical practice.However, my country's basic research and clinical research in the diagnosis and treatment of liver cancer started relatively late, so the high-level evidence-based medicine evidence that can be used to guide clinical practice still comes from clinical research conducted by experts in European and American countries.
In the past two years, immunotherapy and targeted therapy drugs have become the "mainstream" in the treatment of liver cancer, and their combination and integration with local treatments such as surgery and intervention are completely changing the treatment pattern of middle and advanced HCC, and this emerging trend The "torrent" of comprehensive treatment of liver cancer in China has created excellent conditions for China's liver cancer clinical research and real-world research to achieve a leap, and it has also brought historic opportunities for Chinese liver cancer clinical scientists to achieve breakthroughs.
The "Liver Cancer Research Youth Club" (hereinafter referred to as "The Years Club") was established in 2020, focusing on domestic doctors in the middle of the year, and gathering people with lofty ideals in liver cancer surgery, mediation, pathology, imaging and other disciplines across the country.
It is organized by Professor Chen Kuaihua, Honorary Dean of the Third Affiliated Hospital of Sun Yat-sen University and Director of Guangdong Organ Transplant Research Center, and Professor Yang Yang, Deputy Dean of the Third Affiliated Hospital of Sun Yat-sen University and Director of Liver Surgery of the Third Affiliated Hospital of Sun Yat-sen University, China Organizations such as the Health Promotion and Education Association and the Chinese Electronic Journal of Liver Surgery provide support.
On March 1, 2021, the 2020 version of the National Medical Insurance Reimbursement Catalog, which includes lenvatinib and other liver cancer system therapeutic drugs, was officially launched.
The clinical popularization and application of these representative drugs for the treatment of liver cancer is generally believed to greatly promote the clinical research and real-world research of the comprehensive treatment of liver cancer in my country.
Recently, during the National Medical Insurance Launch Conference for the targeted therapy drug lenvatinib for liver cancer, this platform interviewed Professor Yang Yang, director of liver surgery at the Third Affiliated Hospital of Sun Yat-sen University, on the importance of strengthening clinical research on liver cancer treatment in my country.
Reporter: What opportunities does system therapy drugs bring to improve the level of liver cancer treatment? Professor Yang Yang: Since the 1950s, my country's liver cancer surgical treatment research and clinical practice have achieved great success through the unremitting efforts of several generations, and the level of liver cancer surgical treatment has been continuously improved.
However, the overall 5-year recurrence rate after radical resection of liver cancer is still about 60%, even for small liver cancer, the recurrence rate can reach 40%.
The main reason is the spread and metastasis of malignant tumors.China's cancer statistics from 2003 to 2015 show that the overall 5-year survival rate for liver cancer is only 12.
5%, which is much lower than the 60% 5-year survival rate for liver cancer in neighboring Japan.
The rapid development of liver cancer system therapy drugs, especially multi-target small molecule anti-tumor drugs in recent years, has broadened the indications for surgery, allowing those unresectable advanced liver cancers to be transformed into surgically resectable after tumor downgrading, making it impossible before.
Cure patients with advanced liver cancer have a chance of being cured.
In addition, the clinical practice of systemic treatment drugs in preventing postoperative recurrence of patients with a large number of tumors, large overall tumor volume, microvascular invasion, macrovascular invasion, or stage IIb or above, and the treatment of recurrence are also constantly advancing.
It is expected to further improve the survival rate after liver cancer surgery.
Reporter: Why does liver cancer treatment need Chinese research, Chinese data and Chinese voice? Professor Yang Yang: Most of the current systemic treatment drugs for liver cancer come from clinical studies designed and carried out by foreign experts and scholars.
Although many studies have included Chinese patients, in general, these studies are aimed at the global population; however, my country’s HCC is There are huge differences in epidemiological characteristics, molecular behavior, clinical manifestations and staging, treatment strategies, curative effects, and prognosis from liver cancer in European and American countries.
Therefore, treatment strategies need to be formulated based on Chinese data.
In fact, from the data analysis results of the Chinese subgroups of some existing phase III clinical studies, we can already see the peculiarities of the Chinese population.
For example, the results of the Chinese population data analysis of the phase III clinical study REFLECT suggest that for hepatitis B related For unresectable liver cancer, the first-line treatment of lenvatinib has a greater OS benefit than sorafenib.
Reporter: Why does the "Liver Cancer Research Youth Club" focus on comprehensive treatment? Professor Yang Yang: The treatment of liver cancer is increasingly dependent on multidisciplinary comprehensive treatment, and more and more precision and individualization are required.
These new requirements are driving the transformation of hepatobiliary surgery.
But at present, there are few large-sample, prospective comprehensive treatments of liver cancer clinical research results announced on a global scale.
my country has a large number of case data, if the resources can be integrated and used rationally, it will certainly provide favorable evidence-based medical evidence for the standardized treatment of liver cancer; at the same time, it can also be used in the basic research of liver cancer, including the development of new drugs, and optimization of prevention and treatment.
Sections and other fields make greater contributions to the world. Therefore, we hope to build a platform such as the "Liver Cancer Research Youth Club" to carry out clinical research and explore the clinical use value of different combinations of targeted and immunotherapeutic drugs and local treatment methods such as surgery and intervention.
Of course, these explorations are not large-scale clinical studies, but we can find more clinically meaningful and valuable therapeutic clues from these clinical research data results.
Reporter: What is the significance of the inclusion of liver cancer system therapy drugs in the medical insurance reimbursement list for promoting clinical research? Professor Yang Yang: Immunization and targeted drugs can improve the therapeutic effect of liver cancer.
This is a technological advancement.
However, if only a small number of patients can afford these drugs, and most people cannot benefit from them, then this technology will not produce large-scale social benefits, nor will it benefit more patients.
Therefore, the entry of these drugs into medical insurance can ensure that more patients are likely to benefit from survival, thereby transforming advanced technology into the social benefits of long-term patient survival.
At the same time, when more patients can afford to use these drugs, a large amount of data on efficacy and safety can be generated, especially data on comprehensive treatment brought about by the combination of these drugs and different local treatment methods.
The analysis results of these real-world data can guide more research design and clinical practice.
Reporter: Why does the "Liver Cancer Research Youth Club" focus on young doctors? Professor Yang Yang: At present, more and more young doctors are particularly willing to actively participate in clinical research, including surgeons.
Many surgeons may only focus on the improvement of surgical techniques in the past, but in the era of "big fusion" in the treatment of liver cancer, they have also begun to pay attention to comprehensive treatment.
At present, the treatment of liver cancer advocates a multidisciplinary (MDT) treatment model such as surgery, intervention, pathology, and imaging.
The idea behind it is to take the patient as the center, the disease as the center, and not the department as the center.
However, this requires surgeons to "internalize", consolidate the foundation of internal medicine and update their knowledge reserves while improving surgical techniques; that is to say, in addition to having a deep understanding of major liver cancer diagnosis and treatment guidelines, they must also be able to learn from the latest guidelines.
Refine the relationship between disease, test, diagnosis, and therapeutic drugs, and refine the clinical path. In the process of "evolution" and "evolution" of this complex cognition and diagnosis and treatment behavior, young and middle-aged liver cancer experts will undoubtedly become the backbone of promoting the development of the discipline and improving the clinical diagnosis and treatment.
At present, the centers participating in the "Youth Club" project are all relatively large-scale and high-level hospitals in China.
Therefore, the source of enrolled patients is better, the treatment standard is strong, and all parties are more enthusiastic about participating and investing.
Reporter: In addition to the thinking of carrying out clinical research, hepatobiliary surgeons also need to have what new abilities and new qualities to lead the trend of the future? Professor Yang Yang: In addition to knowing how to use a knife, the surgeon also has several other indispensable abilities.
First of all, you must be able to see clearly.
There are many new developments in CT and various DSI, ICT, and MR imaging technologies every year.
Being able to see clearly and understand is to be able to make full use of the data brought by these imaging technologies that assist clinical diagnosis.
This is the most basic and core thing that surgery depends on.
The second is to be able to keep an eye on it.
Faced with many diseases at a complex stage, doctors need to grasp the patient's overall condition for a comprehensive assessment, and cannot afford to lose sight of one to the other.
For example, when designing an operation, we must consider the protection of other organs and the prevention of complications.
Local problems cannot be solved, but systemic problems are fatal, which requires keeping an eye on the whole.
Finally, in the era of comprehensive treatment, surgeons must understand internal medicine.
In addition to using a good knife, they must also be able to play medicine.
Because liver cancer is a systemic disease, surgery alone cannot solve all problems.
Therefore, good use of systemic weapons is a new ability that needs to be cultivated for surgeons.
Of course, how to use it, when to use it, and how to combine it all require research and exploration.
So I think "Youth Club" is beneficial to doctors in the new era of liver cancer treatment.
References: 1.
Top 50 Most-Cited Journal of Clinical Oncology Articles From 2018, J Clin Oncol: 39: 1311-1313, 20212.
Yang H, Liu H, Chen Y, et al: Neoadjuvant chemoradiotherapy followed by surgery versus surgery along for advanced squamous cell carcinoma of esophagus[NEOCRTEC5010]: A phase III multi-center, randomized, open-label clinical trial, J Clin Oncol: 36:2796-2803, 20183.
Chow PKH, Gandhi M, Tan SB, ete al: SIRveNIB: Selective Internal Radiation Therapy Versus Sorafenib in Asia-Pacific Patients With Hepatocellular Carcinoma, J Clin Oncol: 36:1913-1921, 20184.
https://gco.
iarc.
fr/today/data/factsheets/cancers/11-Liver -fact-sheet.
pdf
Among them, a total of 3 Chinese scholars were selected as the first or corresponding authors of the research results, and there is only one study that is completely aimed at the Chinese population, which is a phase III clinical study 2 on neoadjuvant treatment of locally advanced esophageal squamous cell carcinoma.
The only clinical study on the treatment of hepatocellular carcinoma (HCC) was selected from a phase III clinical study led by a Singaporean scholar.
Both esophageal cancer and liver cancer are tumors with Chinese characteristics, and both have the highest morbidity and mortality rates in China.
Chinese scholars in the field of esophageal cancer treatment have obtained high-level evidence-based medical evidence recognized by the world.
It is gratifying and gratifying, but at the same time, it can not help but hope that Chinese scholars will make new breakthroughs in the field of liver cancer treatment research as soon as possible.
China is the country with the largest number of liver cancer cases in the world.
According to the latest global cancer burden data report for 2020 released by the International Agency for Research on Cancer (IARC) under the World Health Organization in February this year, there will be 410,038 new cases of liver cancer in my country in 2020, accounting for 45.
3% of the total global cases (905,677)4 .
About 80% of liver cancers in China originate from hepatitis B virus (HBV) infection.
At the time of initial diagnosis, nearly 80% have developed into intermediate and advanced stages.
The treatment is difficult and the prognosis is poor.
It is significantly different from HCC in Europe, the United States and even Japan.
Therefore, my country’s HCC diagnosis and treatment cannot be based on the experience of Europe, America and Japan.
It must be based on the Chinese population to obtain high-level evidence-based medical evidence, so as to formulate perfect HCC diagnosis and treatment specifications and guide clinical practice.However, my country's basic research and clinical research in the diagnosis and treatment of liver cancer started relatively late, so the high-level evidence-based medicine evidence that can be used to guide clinical practice still comes from clinical research conducted by experts in European and American countries.
In the past two years, immunotherapy and targeted therapy drugs have become the "mainstream" in the treatment of liver cancer, and their combination and integration with local treatments such as surgery and intervention are completely changing the treatment pattern of middle and advanced HCC, and this emerging trend The "torrent" of comprehensive treatment of liver cancer in China has created excellent conditions for China's liver cancer clinical research and real-world research to achieve a leap, and it has also brought historic opportunities for Chinese liver cancer clinical scientists to achieve breakthroughs.
The "Liver Cancer Research Youth Club" (hereinafter referred to as "The Years Club") was established in 2020, focusing on domestic doctors in the middle of the year, and gathering people with lofty ideals in liver cancer surgery, mediation, pathology, imaging and other disciplines across the country.
It is organized by Professor Chen Kuaihua, Honorary Dean of the Third Affiliated Hospital of Sun Yat-sen University and Director of Guangdong Organ Transplant Research Center, and Professor Yang Yang, Deputy Dean of the Third Affiliated Hospital of Sun Yat-sen University and Director of Liver Surgery of the Third Affiliated Hospital of Sun Yat-sen University, China Organizations such as the Health Promotion and Education Association and the Chinese Electronic Journal of Liver Surgery provide support.
On March 1, 2021, the 2020 version of the National Medical Insurance Reimbursement Catalog, which includes lenvatinib and other liver cancer system therapeutic drugs, was officially launched.
The clinical popularization and application of these representative drugs for the treatment of liver cancer is generally believed to greatly promote the clinical research and real-world research of the comprehensive treatment of liver cancer in my country.
Recently, during the National Medical Insurance Launch Conference for the targeted therapy drug lenvatinib for liver cancer, this platform interviewed Professor Yang Yang, director of liver surgery at the Third Affiliated Hospital of Sun Yat-sen University, on the importance of strengthening clinical research on liver cancer treatment in my country.
Reporter: What opportunities does system therapy drugs bring to improve the level of liver cancer treatment? Professor Yang Yang: Since the 1950s, my country's liver cancer surgical treatment research and clinical practice have achieved great success through the unremitting efforts of several generations, and the level of liver cancer surgical treatment has been continuously improved.
However, the overall 5-year recurrence rate after radical resection of liver cancer is still about 60%, even for small liver cancer, the recurrence rate can reach 40%.
The main reason is the spread and metastasis of malignant tumors.China's cancer statistics from 2003 to 2015 show that the overall 5-year survival rate for liver cancer is only 12.
5%, which is much lower than the 60% 5-year survival rate for liver cancer in neighboring Japan.
The rapid development of liver cancer system therapy drugs, especially multi-target small molecule anti-tumor drugs in recent years, has broadened the indications for surgery, allowing those unresectable advanced liver cancers to be transformed into surgically resectable after tumor downgrading, making it impossible before.
Cure patients with advanced liver cancer have a chance of being cured.
In addition, the clinical practice of systemic treatment drugs in preventing postoperative recurrence of patients with a large number of tumors, large overall tumor volume, microvascular invasion, macrovascular invasion, or stage IIb or above, and the treatment of recurrence are also constantly advancing.
It is expected to further improve the survival rate after liver cancer surgery.
Reporter: Why does liver cancer treatment need Chinese research, Chinese data and Chinese voice? Professor Yang Yang: Most of the current systemic treatment drugs for liver cancer come from clinical studies designed and carried out by foreign experts and scholars.
Although many studies have included Chinese patients, in general, these studies are aimed at the global population; however, my country’s HCC is There are huge differences in epidemiological characteristics, molecular behavior, clinical manifestations and staging, treatment strategies, curative effects, and prognosis from liver cancer in European and American countries.
Therefore, treatment strategies need to be formulated based on Chinese data.
In fact, from the data analysis results of the Chinese subgroups of some existing phase III clinical studies, we can already see the peculiarities of the Chinese population.
For example, the results of the Chinese population data analysis of the phase III clinical study REFLECT suggest that for hepatitis B related For unresectable liver cancer, the first-line treatment of lenvatinib has a greater OS benefit than sorafenib.
Reporter: Why does the "Liver Cancer Research Youth Club" focus on comprehensive treatment? Professor Yang Yang: The treatment of liver cancer is increasingly dependent on multidisciplinary comprehensive treatment, and more and more precision and individualization are required.
These new requirements are driving the transformation of hepatobiliary surgery.
But at present, there are few large-sample, prospective comprehensive treatments of liver cancer clinical research results announced on a global scale.
my country has a large number of case data, if the resources can be integrated and used rationally, it will certainly provide favorable evidence-based medical evidence for the standardized treatment of liver cancer; at the same time, it can also be used in the basic research of liver cancer, including the development of new drugs, and optimization of prevention and treatment.
Sections and other fields make greater contributions to the world. Therefore, we hope to build a platform such as the "Liver Cancer Research Youth Club" to carry out clinical research and explore the clinical use value of different combinations of targeted and immunotherapeutic drugs and local treatment methods such as surgery and intervention.
Of course, these explorations are not large-scale clinical studies, but we can find more clinically meaningful and valuable therapeutic clues from these clinical research data results.
Reporter: What is the significance of the inclusion of liver cancer system therapy drugs in the medical insurance reimbursement list for promoting clinical research? Professor Yang Yang: Immunization and targeted drugs can improve the therapeutic effect of liver cancer.
This is a technological advancement.
However, if only a small number of patients can afford these drugs, and most people cannot benefit from them, then this technology will not produce large-scale social benefits, nor will it benefit more patients.
Therefore, the entry of these drugs into medical insurance can ensure that more patients are likely to benefit from survival, thereby transforming advanced technology into the social benefits of long-term patient survival.
At the same time, when more patients can afford to use these drugs, a large amount of data on efficacy and safety can be generated, especially data on comprehensive treatment brought about by the combination of these drugs and different local treatment methods.
The analysis results of these real-world data can guide more research design and clinical practice.
Reporter: Why does the "Liver Cancer Research Youth Club" focus on young doctors? Professor Yang Yang: At present, more and more young doctors are particularly willing to actively participate in clinical research, including surgeons.
Many surgeons may only focus on the improvement of surgical techniques in the past, but in the era of "big fusion" in the treatment of liver cancer, they have also begun to pay attention to comprehensive treatment.
At present, the treatment of liver cancer advocates a multidisciplinary (MDT) treatment model such as surgery, intervention, pathology, and imaging.
The idea behind it is to take the patient as the center, the disease as the center, and not the department as the center.
However, this requires surgeons to "internalize", consolidate the foundation of internal medicine and update their knowledge reserves while improving surgical techniques; that is to say, in addition to having a deep understanding of major liver cancer diagnosis and treatment guidelines, they must also be able to learn from the latest guidelines.
Refine the relationship between disease, test, diagnosis, and therapeutic drugs, and refine the clinical path. In the process of "evolution" and "evolution" of this complex cognition and diagnosis and treatment behavior, young and middle-aged liver cancer experts will undoubtedly become the backbone of promoting the development of the discipline and improving the clinical diagnosis and treatment.
At present, the centers participating in the "Youth Club" project are all relatively large-scale and high-level hospitals in China.
Therefore, the source of enrolled patients is better, the treatment standard is strong, and all parties are more enthusiastic about participating and investing.
Reporter: In addition to the thinking of carrying out clinical research, hepatobiliary surgeons also need to have what new abilities and new qualities to lead the trend of the future? Professor Yang Yang: In addition to knowing how to use a knife, the surgeon also has several other indispensable abilities.
First of all, you must be able to see clearly.
There are many new developments in CT and various DSI, ICT, and MR imaging technologies every year.
Being able to see clearly and understand is to be able to make full use of the data brought by these imaging technologies that assist clinical diagnosis.
This is the most basic and core thing that surgery depends on.
The second is to be able to keep an eye on it.
Faced with many diseases at a complex stage, doctors need to grasp the patient's overall condition for a comprehensive assessment, and cannot afford to lose sight of one to the other.
For example, when designing an operation, we must consider the protection of other organs and the prevention of complications.
Local problems cannot be solved, but systemic problems are fatal, which requires keeping an eye on the whole.
Finally, in the era of comprehensive treatment, surgeons must understand internal medicine.
In addition to using a good knife, they must also be able to play medicine.
Because liver cancer is a systemic disease, surgery alone cannot solve all problems.
Therefore, good use of systemic weapons is a new ability that needs to be cultivated for surgeons.
Of course, how to use it, when to use it, and how to combine it all require research and exploration.
So I think "Youth Club" is beneficial to doctors in the new era of liver cancer treatment.
References: 1.
Top 50 Most-Cited Journal of Clinical Oncology Articles From 2018, J Clin Oncol: 39: 1311-1313, 20212.
Yang H, Liu H, Chen Y, et al: Neoadjuvant chemoradiotherapy followed by surgery versus surgery along for advanced squamous cell carcinoma of esophagus[NEOCRTEC5010]: A phase III multi-center, randomized, open-label clinical trial, J Clin Oncol: 36:2796-2803, 20183.
Chow PKH, Gandhi M, Tan SB, ete al: SIRveNIB: Selective Internal Radiation Therapy Versus Sorafenib in Asia-Pacific Patients With Hepatocellular Carcinoma, J Clin Oncol: 36:1913-1921, 20184.
https://gco.
iarc.
fr/today/data/factsheets/cancers/11-Liver -fact-sheet.
